Margot Sanger Katz at the New York Times raises a critical point about Democratic goals for single payer plans:
Like “repeal and replace,” “single-payer” is a broadly popular slogan that papers over intraparty disagreements and wrenching policy choices. Republicans fumbled multiple attempts to replace the Affordable Care Act this year. If the Democrats eventually wrested back power, they could find themselves similarly factionalized and stymied over the details.
Rep. Conyers has released a set of single payer bills. Senator Sanders is scheduled to release a single payer bill tomorrow. These bills have no chance of becoming law in this session of Congress. Yet they serve a good purpose in building consensus that originates from the intra-party consensus on universal coverage towards the mechanics of achieving that goal.
But the details matter. While it is true, as advocates often mention, that much of the world has some form of universal health care, there is wide variation in how those systems work. Nearly any single-payer plan would require substantial disruptions in the current health care system, upending the insurance arrangements of the 156 million Americans who get their coverage from work, changing the way doctors, hospitals and drug companies are paid, and shifting more health care spending onto the government ledger. Such a proposal would reshuffle the winners and losers in our current system.
If there is going to be a legitimate single payer push the next time there are working and functional universal coverage majorities in Congress, then the details matter. And those details need to be fleshed out. The first drafts (and that is what these bills are) need to be ruthlessly edited. They need experts to look at Section 1422-a-2-b and say that it does not align with Section 332-b nor does it play nicely with established case law and business practices. These drafts need experts to ask if the implied trade-off is actually the trade-off that is intended to be made. These drafts need to be ripped apart for internal weakness and stress tested against plausible events and corner cases.
If people are serious about wanting to move towards some type of single payer system anchored on Medicare as the means towards achieving universality, then the hard work of figuring out how to make things work is needed now. If you want a slogan, than it is fine to be lazy.